Outcomes/Effectiveness Research

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Diabetes has been diagnosed in 12.1 million people in the United States, and it results in nearly 82,000 lower extremity amputations each year. Diabetes is the six leading cause of death and a significant cause of disability, and it accounts for about $132 billion in U.S. health care expenditures.

Two new studies supported by the Agency for Healthcare Research and Quality (K08 HS11418), led by Leonard E. Egede, M.D., M.S., of the Medical University of South Carolina, found that adults with diabetes don't use the emergency department (ED) significantly more often than those without diabetes, and that people with diabetes who are also depressed miss more work due to their conditions than those with either condition alone. Both studies, which are summarized here, involved analysis of data from the 1999 National Health Interview Survey, a nationally representative household survey of U.S. adults aged 18 or older.

This study found that adults with diabetes used the ED more in 1 year than adults without diabetes: one visit (16 vs. 12 percent), two to three visits (8 vs. 4 percent), and four or more visits (3 vs. 1 percent). However, after controlling for factors known to affect ED use—such as age, having a regular source of care, and health status—the odds of ED use were not significantly different between people with and without diabetes (odds ratio [OR], 0.92; 1 is equal odds), suggesting that prevalence estimates alone can be misleading.

Among individuals with diabetes, there were differences in factors associated with single and multiple visits to the ED. For example, diabetes patients who perceived worsening health or had three or more coexisting chronic
conditions in addition to diabetes were nearly twice as likely to use the ED one time (ORs, 1.66 and 1.56, respectively), and those aged 18-34 years were more than twice as likely to do so (OR, 2.35). Correlates of multiple ED use included age 18-34 years (OR, 8.69), unemployment (OR, 2.33), having a usual source of care (OR, 8.45), perceived worsening of health (OR, 2.77), having three or more chronic coexisting conditions (OR, 3.04), and having diabetes-related complications (OR, 2.11).

Egede, L.E. (2004, July). "Effects of depression on work loss and disability bed days in individuals with diabetes." Diabetes Care 27(7), pp. 1751-1753.

From 10 to 30 percent of adults who have diabetes also suffer from depression. Coexisting depression in adult diabetes patients is associated with more days spent in bed for a half day or longer (disability bed days), especially among the unemployed, as well as increased odds of missing work for a week or longer, according to this study. Compared with individuals who did not have diabetes or depression, those with both conditions were 3.25 times as likely to miss a week or more of work. Individuals who had depression alone were 3.08 times as likely to miss a week or more of work, and those with diabetes alone were 1.5 times as likely to miss work.

Similar results were seen for odds of extended disability bed days. People with diabetes were 1.63 times as likely to spend a half day or more in bed for a week or longer, depressed patients were 4 times as likely to do so, and those with both conditions were 5.61 times as likely to spend a week or longer in bed as other individuals.

The results of this study build on findings of an earlier study by this investigator which showed that coexisting depression boosted the likelihood of functional disability in diabetes patients. In combination, these studies demonstrate that coexisting depression among people with diabetes is associated with increased disability burden and lost productivity.